Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage Plans (also known as Medicare Part C) offer the same benefits as Medicare Parts A and B, excluding hospice care, which is exclusive to Part A. However, they may also provide additional benefits unavailable through Original Medicare, such as non-prescription medication coverage or dental care benefits. While benefits vary between providers, companies offering Medicare Advantage policies must include at least the same coverage as regular Medicare.
These plans are available from Medicare-approved private insurance companies. They are subsidized by the government, so there are certain requirements involved. Enrollees must be eligible for Medicare Parts A and B and live within the insurance provider’s service area. Most Medicare Advantage Plans don’t allow people with End-Stage Renal Disease to enroll.
There are various types of Medicare Advantage Plans. Health Maintenance Organization (HMO) plans require enrollees to receive care from providers enrolled in the insurer’s network except in emergencies. Meanwhile, Preferred Provider Organization (PPO) plans cover services from both in-network and out-of-network providers. However, enrollees may pay more for services received outside their insurer’s network. There are also specialized plans (or SNPs) available designed to meet the requirements of people with complex health needs, such as those with chronic health conditions.
The number of Rhode Island residents enrolled in Medicare Advantage Plans increased by 10.34% between 2022 and 2023. This increase in enrollments slightly exceeds the U.S. average of 9.75%. Eligibility for Medicare Advantage also increased by 2.77% in Rhode Island, compared to 2.66% nationwide. Of the Rhode Islanders eligible for Medicare Advantage enrollment, 7.37% more chose to purchase a Medicare Advantage plan in 2023 than in 2022. Nationwide, enrollment among eligible citizens increased by 6.9%. Therefore, Medicare Advantage enrollment is more prevalent in Rhode Island compared to the United States as a whole, and awareness of customizable options is growing.
This guide provides a comprehensive overview of Medicare Advantage options in Rhode Island. It outlines the benefits and coverage offered by these plans, eligibility criteria for enrollment and information on how to choose and enroll in a suitable Medicare Advantage Plan.
The Top Medicare Advantage Plans in Rhode Island
Several types of Medicare Advantage Plans are available in Rhode Island. The following table lists the eight most popular plans, including pricing and enrollment numbers. Medicare Advantage providers typically offer multiple policies. Therefore, the enrollment numbers were combined to determine the total membership for each provider in Rhode Island. The cost ranges account for price differences between plans. All cost and enrollment numbers were accurate as of July 2023, but any senior who needs the current data should visit Medicare.gov or the Centers for Medicare and Medicaid Services to learn more.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
Blue Cross & Blue Shield of Rhode Island
58263
5
$0 – $264
HMO
UnitedHealthcare
29074
3
$0 – $53
PPO, HMO
Blue Cross and Blue Shield
11653
5
$132 – $132
PPO
Anthem Blue Cross and Blue Shield
3815
3.5
$0 – $0
PPO
Wellcare
1852
N/A
$0 – $14
PPO, HMO
Aetna Medicare
922
3.5
$0 – $0
HMO
Blue Cross Blue Shield of Michigan
349
N/A
$0 – $29
PPO
Humana
175
4
$0 – $9
PPO
How Medicare Advantage Plans Work in Rhode Island
Medicare Advantage Plans differ from Original Medicare because they require members to use doctors and hospitals within a specific network. The rules regarding in-network and out-of-network coverage depend on the type of plan selected. In Rhode Island, Medicare Advantage providers offer four main types of plans. More information about each type is available below.
What Medicare Advantage Plans Cover in Rhode Island
Original Medicare doesn’t cover routine vision care, dental care or hearing aids, and coverage for other services may also be limited. What makes Medicare Advantage so attractive to its members is that providers are allowed to offer extra benefits that aren’t included in Original Medicare. Therefore, some plans cover hearing aids, dentures, eye exams and other services. With the exception of hospice care, Medicare Advantage covers the same medically necessary services as Original Medicare, including inpatient hospital care, preventive care, health screenings and diagnostic tests. Some Medicare Advantage plans also cover gym memberships or transportation to medical appointments.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Rhode Island
Most Rhode Island residents qualify for Medicare when they turn 65, but it’s also available to younger adults with certain disabilities. Medicare enrollment is limited to U.S. citizens and lawfully admitted immigrants. To enroll in Medicare Advantage, an applicant must also be eligible for both parts of Original Medicare and live within their selected plan’s service area.
Medicare has specific enrollment periods each year, so it’s important for applicants to time their enrollment carefully. The list below provides details about enrolling in Medicare Advantage for the first time, choosing a different Medicare Advantage Plan or switching from Medicare Advantage to Original Medicare.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Rhode Island
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Executive Office of Health and Human Services (EOHHS)
Rhode Island’s Executive Office of Health and Human Services (EOHHS) serves the state’s seniors through various agencies to help seniors maintain dignity and independence with Medicare counseling, food assistance, adult day services and protective supports. It also provides assistance with long-term-care issues. The EOHHS oversees the Senior Health Insurance Program (SHIP) discussed below.
For information and assistance, call the EOHHS Main Phone Line at 401-462-5274.
Senior Health Insurance Program (SHIP)
Rhode Island’s Senior Health Insurance Program (SHIP) offers seniors and their families free education and counseling to help them make informed choices regarding Medicare coverage. This service is designed to clarify costs and enable beneficiaries to get the most out of their benefits.
SHIP representatives at the state office can be reached by phone at 401-462-0510, and local counselors are available at locations listed below.
Office of Healthy Aging
The Office of Healthy Aging, formerly known as the Division of Elderly Affairs, collaborates with organizations all over the state to connect seniors with resources and information, including healthcare information, and advocate for the rights and comforts of the elderly. It manages a Healthy Aging Help Desk where seniors and caregivers can report elder abuse, financial exploitation and neglect via a secure web portal.
The OHA oversees the Point, a network of services and programs for older residents. There are six regional Point offices throughout Rhode Island with specialists available to connect seniors to local resources for free. These services are available to individuals aged 55 and older, adults living with a disability, or their caregivers. Case Managers provide guidance with health insurance, medical assistance, elder abuse prevention and nutrition services. These trained professionals share important information about local, state and federal programs to enhance well-being and self-sufficiency.
Call the Point’s Central Office at 401-462-4444 for details regarding services, or call 2-1-1. You can also reach out to your nearby regional Point office listed below.Region 1 Office: Tri-County Community Action Agency – Northern RegionServing North Providence, Johnston, North Smithfield, Smithfield, Burrillville and Gloucester Phone: 401-351-2750Region 2 Office: West Bay Community Action PartnershipServing Warwick, West Warwick and East GreenwichPhone: 401-732-4660Email: [email protected]. A web contact form is available here as well.Region 3 Office: Tri-County South Community Action Agency – Southern RegionServing Charlestown, Exeter, Hopkinton, Narragansett, New Shoreham, North Kingstown, South Kingstown, Richmond, West Greenwich, WesterlyPhone: 401-789-3016Region 4 Office: United Way of Rhode IslandServing the entire statePhone: 401-519-0360Region 5 Office: East Bay Community Action Program – Upper Bay RegionServing Barrington, Bristol, East Providence and WarrenPhone: 401-437-1000, ext. 156Region 6 Office: Child and Family Services of Newport CountyServing Newport CountyPhone: 401-849-2300
Warwick Senior Services in Warwick provides SHIP counseling for the community’s older residents by appointment only. The staff screens interested seniors to determine eligibility for Medicare Advantage and other programs using monthly income. The center also offers a legal clinic, tax help and assistance with subsidized housing and heating expenses. It publishes a newsletter to keep local seniors up to date on activities such as workshops.
Call Warwick Senior Services at 401-468-4070 or 401-468-4090 for information or assistance.
Senior Services, Inc.
Senior Services, Inc., is a nonprofit offering a broad range of services for seniors and people with disabilities in northern Rhode Island. As a partner in the state’s Point network, this organization has a Community Information Specialist who shares free information on eligibility for programs, including Medicare Advantage, throughout the state. Its radio program The Senior Scene and public-access television show The Prime of Life are popular area resources for learning about benefits, services and deadlines.
To schedule an appointment with the Community Information Specialist, call 401-766-3734.
West Warwick Senior and Community Center
The West Warwick Senior and Community Center offers the town’s older residents SHIP options, counseling and pharmaceutical assistance in addition to meals, financial education and social activities.
Call the West Warwick Senior and Community Center at 401-822-4450 to set an appointment with a SHIP counselor.
Office of Veterans Services
The Office of Veterans Services can assist Rhode Island veterans with Medicare information. Veteran Affairs benefits include prescription drug coverage which is not affected by enrollment in a Medicare Advantage plan or Medicare Part D plan.
